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Recovery coaches eyed in opioid addiction battle

By Andy Metzger, State House News Service

Updated:
03/30/2017 09:47:47 AM EDT

BOSTON -- While deep-pocketed captains of industry construct a new response to the opioid-addiction epidemic, officials in the government and health-care fields are eyeing the potential of recovery coaches to help treatment, or a new state mandate for insurers to cover 30 days of detox -- up from the current requirement of two weeks.

At the inaugural breakfast of RIZE Massachusetts, which has raised nearly $13 million toward a $50 million goal, Attorney General Maura Healey warned Republican members of Congress who tried and failed to push through legislation last week that would have scaled back Medicaid funding in future years.

"Whatever they want to do down in Washington, they'd better not ever come at us again with a bill that's going to strip funding for much-needed mental-health and drug-substances services. OK?" Healey said.

Much of the discussion was about how a hospital can best encourage opioid addicts to stick with recovery treatment and what the state could do to stanch the flow of poison.

"If today is an average day, and unfortunately it probably is, we will lose six people -- six citizens of the commonwealth -- to overdose," ad magnate Jack Connors told the crowd gathered at the Taj Boston Hotel on Tuesday morning. He said, "We shouldn't really leave this to the government to solve. This is an effort that we all need to be involved in."

Guests heard from Dr. Sarah Wakeman and Raina McMahan, a longtime heroin addict who -- with Wakeman's help and encouragement -- has been drug-free since Aug. 22, 2013.

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McMahan praised Wakeman's judgment-free approach to treating her addiction and for remaining her doctor even after a relapse.

"Now if only we could figure out a way to clone Sarah and make a million more of her, the world would be a much better place, and I think we'd have a lot less addiction," said McMahan, who is now a recovery coach at Massachusetts General Hospital, helping guide others through the process that freed her from her heroin habit.

Wakeman said that unlike other deadly diseases the medical community knows effective treatment methods for opioid addiction, but about 80 percent of people with opioid abuse disorder don't receive any treatment.

The chief of the Bay State's largest provider group and its largest health insurer are both interested in what recovery coaches like McMahan might offer the health care world.

"If recovery coaches (are) part of the solution, let's understand it, let's test it, let's measure it, and then let's support it. And Blue Cross is the leading plan in the state that's prepared to do that," said Blue Cross Blue Shield of Massachusetts President and CEO Andrew Dreyfus.

Dr. David Torchiana, the president and CEO of Partners HealthCare, which includes Massachusetts General Hospital, told the News Service that Partners only has a handful of recovery coaches now and the organization wants to test their effectiveness.

"Intuitively, it's a very compelling idea that this would help," Torchiana said. He said, "What we're hoping to do is to build an evidence base, to demonstrate the effectiveness."

Lora Pellegrini, president and CEO of the Massachusetts Association of Health Plans, said many of the insurers she represents either cover or use them in pilot programs.

Boston Mayor Marty Walsh, who is a longtime recovering alcoholic, told the room that he supports legislation (H 2181) that would expand the legal protections for "good Samaritans" who seek help for someone overdosing. The bill filed by Rep. Elizabeth Malia, a Jamaica Plain Democrat, would also require insurers to cover at least 30 days of detox and stabilization treatment -- up from the 14 days required by a 2014 law.

"By the time you get to 10 days, you're just starting to get clear. And when you get to 20 days, you're a little more clear. That's why we need the 30 days mandatory to make sure that we keep people in there so when they get out of detox they have a better, clearer picture," said Walsh, who also supports a provision of the legislation aiming to divert substance abusers into treatment instead of the criminal justice system.

Dreyfus, whose insurance company counts 2.8 million members, has not staked out a position on a 30-day mandate, but said Blue Cross supported the 2014 law mandating 14 days of treatment.

"We supported the last piece of legislation, so we'd have to look at it, but every time substance use treatment legislation has come before the Legislature we've supported it, so I would expect that we'd support that again, as well," Dreyfus told the News Service.

Pellegrini said there is no evidence showing that the mandated time-periods for detox treatment is effective.

"I think we want to get people the right treatment. It's very individualized," said Pellegrini, who said some people are best helped by treatment involving medication, such as Vivitrol.

Gov. Charlie Baker said he wants to see research on the effectiveness of the 14-day detox mandate before taking a stance on the proposed 30-day mandate. The governor also said "one of the most important things" for recovery is continuing care, which is a "much longer process."

Sen. John Keenan, a Quincy Democrat, filed legislation (S 1103) that would also extend the mandate for detox and stabilization treatment to 30 days.

The Division of Insurance, in conjunction with the Massachusetts Association of Health Plans, has asked insurers to provide it with information sometime this summer about how the 14-day mandate is being implemented, according to the administration.

With board members hailing from blue chip businesses, such as General Electric, Blue Cross and Partners, as well as groups that focus on addiction, such as Learn to Cope and the Dimock Center, RIZE Massachusetts aims to explore new ideas for treating substance abuse disorders.

Health and Human Services Secretary Marylou Sudders told the News Service the group will have more freedom than government agencies and it can potentially generate ideas to improve government programs.

"Government is about intervention and treatment and recovery. That's what we do. We fund services. And the private sector can really incubate and be innovative," Sudders said. She said, "They're free of governmental restrictions."

While opinions vary about best approaches for curbing drug addiction, there is a widely shared belief that it is a major problem that needs to be solved.

"I've never seen anything in my life that can destroy a family or a community like this. It's so much bigger than economics," Baker said.

Torchiana said a number of people who have multiple health emergencies caused by their addiction "never truly get engaged" in their own treatment.

Speaking to the businesspeople gathered in a hotel meeting room overlooking the Public Garden, Healey and Walsh both sought to point out the widespread nature of addiction.

"I see it every day as I come into work, and I know you do as well. It is that pervasive," Healey said.

"There's probably somebody in this room that's struggling with alcohol or drug addiction," Walsh said. "If not, there's probably somebody in this room that has a family member struggling with alcohol or drug addiction -- having breakfast at the Taj on Tuesday morning. This is not an illness or disease that just hits homeless people."

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